565800366-4-17-2024-29-AS-ZCHN-D4F3RJ-20240417182846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800366
Report Date: 04/17/2024
Date Signed: 04/17/2024 06:30:08 PM

Document Has Been Signed on 04/17/2024 06:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ATRIA HILLCREST		FACILITY NUMBER:	565800366
ADMINISTRATOR:	ADAM SYNCHEFF		FACILITY TYPE:	740
ADDRESS:	405 HODENCAMP RD		TELEPHONE:	(805) 373-0606
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	207	CENSUS: 108	DATE:	04/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Remon Pagels, Executive Director		TIME COMPLETED:	04:30 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Zabel Chochian arrived unannounced to conduct a required annual visit. The LPA met with Executive Director Remon Pagels and reason for the visit was explained.

At approximately 1:45pm, the LPA, Executive Director Remon Pagels and Maintenance Director Hector Arjon toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations.

Common Areas: The facility is a three-story building. Facility elevators were operating properly. There are three stairwells that all have emergency evacuation chairs on the third floor. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the second floor is designated for residents in the memory care unit. There is a central entry point for universal screening. There was hands-free hand sanitizer interspersed throughout the common areas. There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature at 71 degrees Fahrenheit. The fire extinguishers were charged and last serviced 1/3/2024. Smoke detectors and carbon monoxide detectors are tested yearly - The facility uses Johnson Controls to inspect their fire suppression system with the last inspections being conducted on July 11, 2023 through July 12, 2023. According to Maintenance Director the facility maintenance staff conducts monthly inspections of all smoke and carbon monoxide detectors with the last inspection being conducted in March 2024. Required postings observed on the first floor.

Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair. There is a movie theater, hair salon and exercise/therapy room for residents use.

Kitchen: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. The facility also has an emergency supply of food and water. The menu was posted and copies are available near the elevators for residents to take. The facility offers daily specials and a standard selection at every meal. Appliances appeared to be in operable condition. (Continue to LIC809c).

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 04/17/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Resident Rooms: The LPA toured eight (8) randomly selected resident rooms (both the memory care and assisted living unit). Rooms appeared well kept, with sufficient lighting and appropriately furnished. Restrooms: Resident restrooms observed fully stocked with supplies; grab bars and non skid mat/floor surface. The water temperature was tested on all floors and water temperature ranged from 114-115 degrees Fahrenheit.

Interviews: LPA interviewed five residents during the tour and no concerns were noted.

Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There was an enclosed patio for residents whom reside in the memory care unit on the second floor. Delayed egress doors checked and were operable at the time of visit.

Due to time constraints, the annual inspection will be completed on a follow-up visit.

No deficiencies cited at this time. Exit interview conducted. Cope of report provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2